Preoperative Prostate MRI Predictors of Urinary Continence Following                     Radical Prostatectomy

Lamberg, Hannah; Shankar, Prasad R.; Singh, Karandeep; Caoili, Elaine M.; George, Arvin; Hackett, C.; Johnson, Anna; Davenport, Matthew S.

doi:10.1148/radiol.210500

Cited by 14 publications

(21 citation statements)

References 34 publications

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“…The present study investigated the factors that influence the ULR in the early postoperative period using various preoperative and postoperative factors and operative techniques, as well as various postoperative dynamic MRI measurements. Additionally, in the present study, as in previous reports, older age was a risk factor for postoperative urinary incontinence 22 – 24 and longer MUL measured by MRI was associated with better urinary continence 3 – 7 . The results also showed that PB-AR shortening measured by dynamic MRI during abdominal pressure was favorable for urinary continence (Table 2 , Multivariate 2).…”

Section: Discussionsupporting

confidence: 86%

“…Many studies reported on factors that affect urinary incontinence after RP. The present study identified older age 22 – 24 , and shorter MUL 3 – 7 as worsening factors for postoperative urinary incontinence, as has been previously reported. Regarding operative technique, NS 15 – 17 and Retzius-sparing 12 – 14 were identified as favorable factors for postoperative urinary continence, and their combined use was shown to have an additive urinary continence effect.…”

Section: Discussionsupporting

confidence: 86%

“…The main cause of urinary incontinence after RP is thought to be stress urinary incontinence (SUI) 2 ; however, the mechanism is not fully understood. Recently, many anatomical studies that use magnetic resonance imaging (MRI) have reported that membranous urethral length (MUL) affects postoperative urinary continence, which may be related to resting urethral closure pressure 3 – 7 . The mechanism of SUI has also been investigated using transperineal ultrasound and dynamic MRI, and several studies reported on the relationship between pelvic anatomy changes during abdominal pressure and postoperative urinary incontinence 8 – 11 .…”

Section: Introductionmentioning

confidence: 99%

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Contribution of Retzius-sparing robot-assisted radical prostatectomy to the mechanism of urinary continence as demonstrated by dynamic MRI

Kadono

Nohara

Kawaguchi

et al. 2023

Sci Rep

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Retzius-sparing robot-assisted radical prostatectomy (RARP) has been reported to exhibit better postoperative urinary continence, but the reasons behind this are unknown. This study included 254 cases who underwent RARP and underwent postoperative dynamic MRI. We measured the urine loss ratio (ULR) immediately after postoperative urethral catheter removal and investigated its affecting factors and the mechanisms. Nerve-sparing (NS) techniques was performed in 175 (69%) unilateral and 34 (13%) bilateral cases, whereas Retzius-sparing in 58 (23%) cases. The median ULR early after indwelling catheter removal in all patients was 4.0%. The multivariate analysis was performed on factors that reduce ULR and found that the following factors were associated with ULR: younger age, NS and Retzius-sparing, which were significant. Additionally, dynamic MRI findings showed that membranous urethral length and the anterior rectal wall movement toward the pubic bone during abdominal pressure were significant factors. The movement observed on the dynamic MRI during abdominal pressure was thought to reflect an effective urethral sphincter closure mechanism. Long membranous urethral length and an effective urethral sphincter closure mechanism during abdominal pressure were considered effective for favorable urinary continence after RARP. NS and Retzius-sparing were clearly shown to have an additive effect in preventing urinary incontinence.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Contribution of Retzius-sparing robot-assisted radical prostatectomy to the mechanism of urinary continence as demonstrated by dynamic MRI

Kadono

Nohara

Kawaguchi

et al. 2023

Sci Rep

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“…Several studies have studied the observer agreement, which can be measured by the intraclass correlations coefficient (ICC). The agreement results are variable [ 16 ], from fair agreement (ICC 0.34–0.38) [ 17 , 18 ] to high agreement (ICC 0.89) [ 19 ]. Training has been shown to improve the interobserver agreement [ 18 ].…”

Section: Anatomical Parameters To Predict Urinary Continence After Ra...mentioning

confidence: 99%

Prostate MRI for Improving Personalized Risk Prediction of Incontinence and Surgical Planning: The Role of Membranous Urethral Length Measurements and the Use of 3D Models

Boellaard

Hagens

Veerman

et al. 2023

Life

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Prostate MRI has an important role in prostate cancer diagnosis and treatment, including detection, the targeting of prostate biopsies, staging and guiding radiotherapy and active surveillance. However, there are other ‘’less well-known’’ applications which are being studied and frequently used in our highly specialized medical center. In this review, we focus on two research topics that lie within the expertise of this study group: (1) anatomical parameters predicting the risk of urinary incontinence after radical prostatectomy, allowing more personalized shared decision-making, with special emphasis on the membranous urethral length (MUL); (2) the use of three-dimensional models to help the surgical planning. These models may be used for training, patient counselling, personalized estimation of nerve sparing and extracapsular extension and may help to achieve negative surgical margins and undetectable postoperative PSA values.

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“…Even though the impact of the presence of mpMRI imaging might not have influenced the decision for prostatectomy or the nervesparing approach in this investigation, the intraoperative mpMRI usage by the surgeon can have an impact on the postoperative characteristics and the performance of the operation. 7,8 All five surgeons had access to the mpMRI images and radiological reporting, but the extent of intraoperative usage of this information has not been documented and cannot be assessed within the confines of this study or the accrued data.…”

Section: To the Editor/vis Response To Prof Wei And Colleaguesmentioning

confidence: 99%

Reply to Wei Qiang's et al. Letter to the Editor re: Impact of mpMRI‐targeted biopsy on intraoperative nerve‐sparing (NeuroSAFE) during robot‐assisted laparoscopic radical prostatectomy

Leitsmann¹,

Popeneciu²

2022

The Prostate

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Preoperative Prostate MRI Predictors of Urinary Continence Following Radical Prostatectomy

Cited by 14 publications

References 34 publications

Contribution of Retzius-sparing robot-assisted radical prostatectomy to the mechanism of urinary continence as demonstrated by dynamic MRI

Contribution of Retzius-sparing robot-assisted radical prostatectomy to the mechanism of urinary continence as demonstrated by dynamic MRI

Prostate MRI for Improving Personalized Risk Prediction of Incontinence and Surgical Planning: The Role of Membranous Urethral Length Measurements and the Use of 3D Models

Reply to Wei Qiang's et al. Letter to the Editor re: Impact of mpMRI‐targeted biopsy on intraoperative nerve‐sparing (NeuroSAFE) during robot‐assisted laparoscopic radical prostatectomy

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